United Healthcare (Optimum Health Bariatric Resources)

[ribearty 544]

I just spoke to Optum today. The requirements are related to UHC and your employer's insurance contract criteria. I called 3 weeks ago, and was told it could take up to three weeks before I received a call back.

*Additional items may be identified by your BRS Case Manager, based on your situation. The medical centers and programs within Bariatric Resource Services are independent contractors who render care and

Morbid Obesity Surgery Requirements*:

AGE

You must be between the ages of 18-65 years

BMI

Your body mass index (BMI) must be at least 35-39.9 with at least one obesity-related medical condition (i.e. diabetes, high blood pressure, sleep apnea) or over 40.

You can calculate your BMI at: http://www.myoptumhe.../BMI Calculator

NETWORK

You must use a Bariatric Resource Service (BRS) Center of Excellence. If one is greater than 50 miles from your home, you may use an in-network provider.

DIET

You are required to complete a 6 month physician supervised diet, prior to surgery. This means that you have worked with a provider (any licensed physician, nutritionist or Registered Dietician) and had a minimum of one visit per month for 6 months.

During each visit, the provider must document your current weight, what diet regimen you are following and what type and amount of exercise you are performing. Diet must have been completed within the last two years.

If you went to Weight Watchers or Jenny Craig, please provide a copy of all the stamps for 6 months AND at least two physician office visit notes showing appointment date, your weight and that you were participating in Weight Watchers or Jenny Craig. Please use the form that has been provided to you to record these visits.

PSYCHOLOGICAL EVALUATION

You must complete a psychological evaluation within 12 months of your surgery date. Contact United Behavioral Health at the number located on the back of your member ID card.

PROCEDURES ALLOWED

Roux-en-Y, Lap band, Duodenal Switch and Gastric Sleeve are all covered procedures under your plan.

SECOND PROCEDURE

This benefit is limited to one procedure per lifetime while covered under the plan, unless there are complications relating to the initial surgery. A clinical review will be necessary.

I am submitting for revision from band to sleeve and was told that the doctor could submit early if complications were found from the band. She told me that if they submit the review board has 15 days to respond and it normally does not take that long.

I believe that after everything is sent in for a normal review, they have 30 days to respond, but most everyone I know has received a reply in 15 days or less..

The Optum rep told me she would follow up with me in two months but normally, she follows up at 4 months to check in and remind you of the rest of tests needed by your insurance company.

The Optum rep also told me that they go by the BMI first submitted. So if you are submitted with a BMI of 35 and one approved omorbitdity and lose weight, you will still be approved.

Hope this helps.

[beachgirlaz52 2]

I have United Health Care - Optimum Bariatric Resources and I was told I did not need the 6-month dr. supervised diet - I have not gotten final approval yet but I have been told it looks "good" so I am optimistic.

[rostoswr 0]

I have United Healthcare and Optimum. I spoke with a case manager a week ago and she told me the approvals generally take 15 business days. She said right now the approvals are taking 10-15 business days. I am waiting to here back from my surgeon office for my final approval. I am hoping to have surgery sometime in September....start training for a new position next week so I have to push it out a little.

[Heather3344 1]

First post...Monday I finished my 6 month weigh in. Dr faxed over everything to surgeon this afternoon and was submitted late this afternoon. I also have optum health with united. So ready for this to happen. I was also told to not worry if it goes to 15 days, they are slammed right now. Having the surgery in St. Petersburg FL. With Dr. Rehnke.

[aksmith 30]

After reading these posts, I can see that my story was unique. My last nutritionist visit was 7/13, all paperwork was faxed off on 7/16. My dr's office was so confident of the approval, I started my pre-op diet that day and was scheduled for surgery the following week. I called UHC to verify the receipt of my info. I was approved 7/22 and sleeved on 7/23. I'm one week out and adjusting to the "sleeved life"!!

[Pastor Paula Jackson 91]

I have The same insurance but for Rail Roaders so different guidelines. A nurse name Lynn called me! That was the worse phone call of my life. She was beyond rude, and insensitive to how this decision to have surgery is a emotional one on anyone! I called the supervisor and was greeted with a handful of I'm sorry's and let's make this better! They assigned me a new nurse, who suppose to call me ASAP. "that was Thursday. Then Friday 8/1/13. my surgeons office call me to tell me called and requested my file! OMG! Monday can't get here fast enough! I'm just hoping for the best! Everybody pray for me! Because that woman is a Vacation!

[Pastor Paula Jackson 91]

I have The same insurance but for Rail Roaders so different guidelines. A nurse name Lynn called me! That was the worse phone call of my life. She was beyond rude' date=' and insensitive to how this decision to have surgery is a emotional one on anyone! I called the supervisor and was greeted with a handful of I'm sorry's and let's make this better! They assigned me a new nurse, who suppose to call me ASAP. "that was Thursday. Then Friday 8/1/13. my surgeons office call me to tell me Lynn called and requested my file! OMG! Monday can't get here fast enough! I'm just hoping for the best! Everybody pray for me! Because that woman is a Vacation![/quote']

[Pastor Paula Jackson 91]

I have The same insurance but for Rail Roaders so different guidelines. A nurse name Lynn called me! That was the worse phone call of my life. She was beyond rude' date=' and insensitive to how this decision to have surgery is a emotional one on anyone! I called the supervisor and was greeted with a handful of I'm sorry's and let's make this better! They assigned me a new nurse, who suppose to call me ASAP. "that was Thursday. Then Friday 8/1/13. my surgeons office call me to tell me Lynn called and requested my file! OMG! Monday can't get here fast enough! I'm just hoping for the best! Everybody pray for me! Because that woman is a Vacation![/quote']

[SuNMooNStaRS816 423]

I have The same insurance but for Rail Roaders so different guidelines. A nurse name Lynn called me! That was the worse phone call of my life. She was beyond rude' date=' and insensitive to how this decision to have surgery is a emotional one on anyone! I called the supervisor and was greeted with a handful of I'm sorry's and let's make this better! They assigned me a new nurse, who suppose to call me ASAP. "that was Thursday. Then Friday 8/1/13. my surgeons office call me to tell me called and requested my file! OMG! Monday can't get here fast enough! I'm just hoping for the best! Everybody pray for me! Because that woman is a Vacation![/quote']

I am so sorry you had at bad experience. I also have UHC through the rail road. I hope all goes well for you from here on out. Keep us updated!!! Prayers and good vibes sent your way!!!

[Pastor Paula Jackson 91]

I am so sorry you had at bad experience. I also have UHC through the rail road. I hope all goes well for you from here on out. Keep us updated!!! Prayers and good vibes sent your way!!!

How long after the surgeons office submitted your file did you receive a approval? And why in the world did this woman request my file after I had her supervisor switch her for another nurse?

[SuNMooNStaRS816 423]

How long after the surgeons office submitted your file did you receive a approval? And why in the world did this woman request my file after I had her supervisor switch her for another nurse?

I am also pre op. I have 2 visits left in a 6 month supervised diet. I have no idea why she would be requesting your file. I was told by April, my nurse, that they have 14 days to respond. I would definitely call Monday to find out what's going on.

[Pastor Paula Jackson 91]

I am also pre op. I have 2 visits left in a 6 month supervised diet. I have no idea why she would be requesting your file. I was told by April' date=' my nurse, that they have 14 days to respond. I would definitely call Monday to find out what's going on.[/quote']

You know our policy do not need 6 visits in a row! But it has to be 6 over all visits in the past 24 months and you discussed weight loss or diet and you are all good! I got my 6 month done in one! I just had all my visit notes sent over, along with my Psych eval and letter of reference sent to surgeons office. I complained about my weight for the past 3 years, and if i started a new diet i went to see my doctor first to get cleared because i have lung disease and don't want any flare ups. So that part we easy for me. But I am going to defiantly call to see what the dragon lady wanted with my medical records! Especially when the nurses have nothing to do with approval! That's a different department.

[SuNMooNStaRS816 423]

Unfortunately, my PCP did not keep great notes. She had note wgts and hadn't made enough notes about my wgt at all. So had to start from scratch on that. But it's all gone great no issues and I have seen the nutritionist and gotten to know my surgeon really well over this time. It has been a great experience and I feel I am very well prepared for surgery and post op. I feel it will make transitioning in to a new healthier lifestyle much easier. The worst part of this has been stressing over the part of the insurance company. It feels like the hold our lives in their hands.

Hope it goes well for you and your headed to the losers bench soon!!! Good luck!!! Let us know what happens...

[HoustonTexanFan 6]

I also have uhc and in the booklet that has all of my coverage info, under bariatric services it has requirements an it says to contact bariatric resource services. MyOptumhealthcomplexmedical.com

Im going to my very first visit August 6 (Tuesday) an I'm excited but at the same time a little nervous. I don't want to have to wait another 6 months to do diet program. I no one of u said that they don't have to be consecutively. With my insurance how do I find out if they have to be over a certain period of time or be consecutively?

[SuNMooNStaRS816 423]

I also have uhc and in the booklet that has all of my coverage info' date=' under bariatric services it has requirements an it says to contact bariatric resource services. MyOptumhealthcomplexmedical.com

Im going to my very first visit August 6 (Tuesday) an I'm excited but at the same time a little nervous. I don't want to have to wait another 6 months to do diet program. I no one of u said that they don't have to be consecutively. With my insurance how do I find out if they have to be over a certain period of time or be consecutively?[/quote']

Call bariatric resources. They will outline all of your requirements and tell you exactly what you have to do.